Intensification of Anemia by Secondary Hyperparathyroidism in Hemodialysis Patients

The excessive amounts of parathyroid hormone in secondary hyperparathyroidism (SHPTH) is suggested to interfere with normal erythropoiesis. In SHPTH, during chronic renal failure, due to the impairment of erythropoietin synthesis, this effect is more pronounced. In the present study the role of secondary hyperparathyroidism in the severity of anemia was evaluated in hemodialysis patients (n=36; 16 females and 20 males) with the end-stage renal failure. CBC, Hgb, Hct, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), serum iron, total iron binding capacity, transferin saturation, ferritin as well as dialysis adequacy were measured. Partial correlation test was performed for analysis of the data making adjustments for age, duration of hemodialysis and ferritin levels. The mean±SD for iPTH, Hgb and Hct were 439.4 ± 433 pg/ml, 9 ± 1.9 and 28.8 ± 6.3 respectively. The mean duration of hemodialysis for the patients was 25.1 ± 24 months. A reverse correlation was found between iPTH and Hct and Hgb as well as between alkaline phosphatase and Hgb and Hct (0<0.05). It was shown that severity of hyperparathyroidism correlated with severe of anemia. It is concluded that secondary hyperparathyroidism per se can intensify anemia in hemodialysis patients. A more efficient control of hyperphosphatemia and parathormone hypersecretion is thus needed to achieve a better management of anemia in hemodialysis patients.